Tough work

For patients, high-quality nursing care is an alternative option, but the price has risen in line with improved standards. The United Family Healthcare in Beijing provides home healthcare for chronically ill patients and the elderly from qualified doctors and nurses. An initial assessment and six visits a year costs 10,888 yuan, but five home visits a week costs 178,888 yuan per annum.

For those unable to afford the cost, hugong are the only choice, according to Luo.

Cheng Jianhua, 43, from Sichuan province, was once a freelance hugong. She is now a full-time employee at the intensive care unit of the Peking Union Medical College Hospital in Beijing. [Zhang Wei / China Daily]

"Taking care of patients is tough work and sometimes a dirty job," said Luo, referring to cleaning patient waste and the dangers of becoming infected. "Most hugong are from the countryside and lack proper education and skills."

She also said few hugong have personal insurance or receive any welfare, such as insurance or holiday pay. Their working day may be as long as 24 hours, but the wages remain low. Unless they are fired for a misdemeanor, once they are employed, the hugong don't stop working until the patients are discharged from the hospital.

In fact, hugong are often regarded as de facto servants and so their social status is low. Lang told of how a patient poked him with a stick every night to wake him when his urine bag needed changing.